Tromboembolismo venoso en UCI / Venous thromboembolism in the ICU

Marzo 17, 2016. No. 2268

Heparina de bajo peso molecular y compresión neumática intermitente para tromboprofilaxis en pacientes graves Low-molecular-weight heparin and intermittent pneumatic compression for thromboprophylaxis in critical patients. Wan B, Fu HY, Yin JT, Ren GQ. Exp Ther Med. 2015 Dec;10(6):2331-2336. Epub 2015 Oct 13. Abstract The efficacy and safety of physiotherapeutic prophylaxis for venous thromboembolism in critically ill patients with heparin contraindication remains unclear. In the present study it was hypothesized that physiotherapy prophylaxis with intermittent pneumatic compression (IPC) would be safe and effective for patients unable to receive low-molecular-weight heparin (LMWH). In addition, this study investigated whether a combined therapy of IPC with LMWH would be more effective for the prophylaxis of deep vein thrombosis (DVT) in critical patients. A total of 500 patients were divided into four groups according to the prophylaxis of DVT. The IPC group consisted of 95 patients with heparin contraindication that received IPC treatment; the LMWH group consisted of 185 patients that received an LMWH injection; the LMWH + IPC group consisted of 75 patients that received IPC treatment and LMWH injection; and the control group consisted of 145 patients that received no IPC treatment or injection of LMWH. Each patient was evaluated clinically for development of DVT and the diagnosis was confirmed by Doppler study. Venous thromboembolism was a common complication among the trauma patients with severe injuries. Patients responded positively to the treatment used in the intervention groups. Patients exhibited an improved response to LMWH + ICP compared with IPC or LMWH alone, while no significant difference was detected between the IPC and LMWH groups. These results were applicable to patients that had a Wells score of ≥3; however, no significant differences in DVT incidence were observed among the patients who had a Wells score of <3. In this observational study, LMWH + ICP appeared to be more effective than either treatment alone in treating critically ill trauma patients with severe injuries that are at high risk for VTE and bleeding simultaneously. KEYWORDS: deep venous thrombosis; intermittent pneumatic compression; low-molecular-weight heparin PDF Tromboembolismo venoso en UCI. Principales características, diagnóstico y tromboprofilaxis Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, Cartier JC, Ferretti G, Schwebel C, Timsit JF. Crit Care. 2015 Aug 18;19:287. doi: 10.1186/s13054-015-1003-9. Abstract Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication ofcritical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Libros de neumología / E-books on pulmonology

Marzo 19, 2016. No. 2270

Perspectivas clínicas en Enfermedad Pulmonar Obstructiva Crónica COPD Clinical Perspectives Edited by Ralph J. Panos, ISBN 978-953-51-1624-0, 206 pages, Publisher: InTech, Chapters published July 16, 2014 under CC BY 3.0 license DOI: 10.5772/57036 Libro / Book Inflamación pulmonar Lung Inflammation Edited by Kian Chung Ong, ISBN 978-953-51-1373-7, 118 pages, Publisher: InTech, Chapters published May 14, 2014 under CC BY 3.0 license DOI: 10.5772/57068 Libro / Book Enfermedades respiratorias e infecciones. Una nueva visión Respiratory Disease and Infection - A New Insight Edited by Bassam H. Mahboub, ISBN 978-953-51-0968-6, 260 pages, Publisher: InTech, Chapters published February 06, 2013 under CC BY 3.0 license DOI: 10.5772/46040 Libro / Book Perspectiva global sobre broncoscopía Global Perspectives on Bronchoscopy Edited by Sai Praveen Haranath and Samiya Razvi, ISBN 978-953-51-0642-5, 252 pages, Publisher: InTech, Chapters published June 13, 2012 under CC BY 3.0 license DOI: 10.5772/1452 Libro / Book Enfisema Emphysema Edited by Ravi Mahadeva, ISBN 978-953-51-0433-9, 142 pages, Publisher: InTech, Chapters published March 30, 2012 under CC BY 3.0 license DOI: 10.5772/1189 Libro / Book Embolismo pulmonar Pulmonary Embolism Edited by Ufuk Çobanoğlu, ISBN 978-953-51-0233-5, 246 pages, Publisher: InTech, Chapters published March 14, 2012 under CC BY 3.0 license DOI: 10.5772/1493 Libro / Book

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

TEP / Pulmonary embolism

Marzo 18, 2016. No. 2269   Estimad@ Dr@ Víctor Valdés:

Avances recientes en el manejo del embolismo pulmonar. Enfoque en el paciente grave Recent advances in the management of pulmonary embolism: focus on the critically ill patients. Meyer G, Vieillard-Baron A, Planquette B. Ann Intensive Care. 2016 Dec;6(1):19. doi: 10.1186/s13613-016-0122-z. Epub 2016 Mar 3. Abstract The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock. Given at current dosage, thrombolytic therapy is associated with a reduction in the combined end-point of mortality and hemodynamic decompensation in patients with intermediate-risk PE, but this is obtained without a decrease in overall mortality and with a significant increase in major extracranial and intracranial bleeding. In patients with high-intermediate-risk PE, thrombolytic therapy should be given in case of hemodynamic worsening. Vena cava filters are of little help when anticoagulant treatment is not contraindicated, even in patients with PE and features of clinical severity. Finally, direct oral anticoagulants have been shown to be as effective as and safer than the combination of low molecular weight heparin and vitamin K antagonist(s) in patients with venous thromboembolism and low- to intermediate-risk PE. KEYWORDS: Pulmonary embolism; Right ventricle; Risk stratification; Thrombolysis PDF Prevalencia de TVP en pacientes agudos ambulatorios admitidos en UCI no quirúrgica Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients. Lawall H, Oberacker R, Zemmrich C, Bramlage P, Diehm C, Schellong SM. BMC Res Notes. 2014 Jul 5;7:431. doi: 10.1186/1756-0500-7-431. Abstract BACKGROUND: Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. METHODS: Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. RESULTS: VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). CONCLUSIONS: Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015